fluttering muscles

[yaya59]

I have been as to what I call muscle fluttering, no pain, just excessive fluttering especially in feet, both big toes almost constantly move. It started in the feet and radiated up to the calves, then on up to thigh, butt, back, shoulders. but the feet and calves are the worst. the skin of my hands and forearms and feet and upper front of thighs have burning sensation at times, always at night wakes me up. Once i get up the burning seems to lessen or go away.

i have had 2 metabolic rates, they were fine. I had an xray on back which showed arthritis, spondyliois, scoliosis .
Then a nerve conduction test, normal.then Mri which showed L4 and L5 bulging disc.  I do have FMS pretty bad.

but i am concerned if it is really something serious and i am not getting my point across!   When i am tired it is worse, extremely worse! I do not have a good sleep pattern, can't stay asleep even w/ med's, until several days of exhaustion.

sometimes I feel small jerks, but these only appear when i am extremely tired. where do i go and what do I do. this is 4 yrs of this, now i am becoming depressed and worried.   thanks Yaya

[psychosomatic74]

Hello Dr. Chanine,
please advise me.
End of July ’08, after gym sessions felt progressive right calf stiffness and pain only after the last one which stopped me from exercising further.
Physician put me on 2 weeks ketoprofen orally which relieved pain but no stiffness. Days after end of treatment had a single bad cramp on right calf lasted some hours, went to general neurologist  (thorough clinical neuro exam. was completely normal), also made venous eco-doppler on both legs which was normal.
Beg. of Sept. ’08 felt sudden right arm weakness and made another thorough clinical exam. with neuromuscolar neurologist and brain CT without contrast, everything normal, “I strongly believe it is psychological” was the response (weakness faded disappearing totally after several days.).
Mid September went to my “favourite neurologist” (retired but very experienced and smart, was Head of Neurology Dept. of the hospital of my city) and ordered extremely extensive blood work (I felt like blood donor!), brain, cervical and lumbar RMN’s all normal.
End of Sept. ‘08 stiffness spread to left calf and slightly to right quadriceps, physiotherapist found some minor contractures. Started feeling very few fasciculations in legs, right hand, forearms and minor cramping of right quadriceps (discontinuous, lasted many weeks, fluctuating).
End Oct. ‘08 stiffness spread to both upper forearms (more left), neck, face, went to “favourite neuro” for clinical thorough examination which was normal again. Lower limbs EMG/NCS was clean too. He put me on 0,5 mg. delorazepam 3 times a day and he was convinced it is stress/psychosis together with a peripheral nerve hyperexcitability (BFS/BCFS). Treatment showed good response on symptoms but in the meantime I got very scared about ALS.
Mid Nov. ’08 felt stiffness on left emi-thorax, slight breathing difficulties and fatigue on that side,  made Thorax RX, ECG, complete blood work and thorough clin. neuro examin. all negative. By increasing delorazepam dosage slightly, emi-thorax sympt. improved and faded away in some time.
End November ‘08 made lower and upper limb needle EMG/NCS with neuromuscolar neurologist, was clean, and he told me it’s not BCFS, “it’s an psychosomatic issue”.
End December ’08 felt intermittent pain in feet after walking and feet, legs, reported to a third  neurologist who carried out needle EMG/NCS (clean) on all limbs and adviced me SSRI (but I went on with benzos).
End January/beginning February ’09 stopped delorazepam very smoothly and after some weeks stiffness in limbs came back almost totally together with few widespread fasciculations and occasional random minor cramping. Reported all new symp. to “favourite neuro”, made a thorough clinical examination, all perfect and reassured me it is NOT ALS, it is BFS/BCFS.
End of February ’09 went to neuromuscolar neurologist reporting the same plus perceived light right hand weakness and minor occasional tingling/twitching external hand, made surface EMG/NCS, clean (response: benign ulnar nerve compression), made a thorough clinical examination – normal – and told me IT IS NOT ALS OR MND, it a psychosomatic issue and adv. to go on with benzos (until beginning of summer) and look for a good Psychologist.
End of march ’09 made a 4 limbs needle EMG/NCS by my 3rd neurologist, clear again. He thinks that is NOT BFS/BCFS because it seem to be progressive and advised again SSRI.
A couple of weeks ago I started feeling slight fatigue/weakness(?) on right arm and right quadriceps and occasional internal forearm spasm/cramping exercising, slight emi-thorax sympt again and increasing odd feelings in mouth: stiffness of bottom of tongue like pulling it, tongue tremor (internal fasciculations?), occasional slight slurred speech and slight swallowing difficulties (like lump in throat?). Some days ago the otorhinolaryngologist visited me and asked if I had ALS/MS in family but told that on examination was everything ok.
I am dead scared I have predominant upper motor neurone disease which will turn to classical ALS with time. Please advise me.

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Your symptoms of tingling and burning in your hands and feet could potentially be related to a neuropathy, a problem with the peripheral nerves of the hands and feet. There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved ,weakness. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes. There are several other causes.

If your symptoms only occur in the evening or at night and are associated with an urge to move, and if they improve with movement, it is possible they are caused by a condition called restless legs syndrome, a benign condition that is treatable.

Regarding your muscle fluttering, which I will assume are twitches, these may be due to benign fasciculation syndrome, which I will abbreviate as BFS, a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. These may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low. hen BFS is present but not particularly bothersome or disabling, treatment is not necessary. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

In general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem.

I suggest follow up with your primary doctor and you may benefit from evaluation by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her. Further evaluation may include a study called EMG/NCS, which can assess how the nerves conduct electricity and how muscles respond, to assess for neuropathy and for other causes of twitching.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.